Predictors of disparity between targeted and in-zone systematic cores during transrectal MR/US-fusion prostate biopsy

Paige K Kuhlmann; Michelle Chen; Michael Luu; Aurash Naser-Tavakolian; Hyung L Kim; Rola Saouaf; Timothy J Daskivich

doi:10.1016/j.urolonc.2021.12.016

Predictors of disparity between targeted and in-zone systematic cores during transrectal MR/US-fusion prostate biopsy

Urol Oncol. 2022 Apr;40(4):162.e1-162.e7. doi: 10.1016/j.urolonc.2021.12.016. Epub 2022 Jan 20.

Authors

Paige K Kuhlmann¹, Michelle Chen², Michael Luu³, Aurash Naser-Tavakolian⁴, Hyung L Kim⁵, Rola Saouaf⁶, Timothy J Daskivich⁷

Affiliations

¹ Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: paige.kuhlmann@cshs.org.
² University of California San Diego School of Medicine, San Diego, CA. Electronic address: michelleschen@ucla.edu.
³ Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Michael.luu@cshs.org.
⁴ Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: aurash.naser-tavakolian@cshs.org.
⁵ Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: hyung.kiml@cshs.org.
⁶ Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: rola.saouaf@cshs.org.
⁷ Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: timothy.daskivich@cshs.org.

PMID: 35067431
DOI: 10.1016/j.urolonc.2021.12.016

Abstract

Background: The combination of targeted and systematic biopsies during MR/US-fusion prostate biopsy improves cancer detection over either modality alone.

Objective: To identify factors associated with disparity in detection of prostate cancer between systematic and targeted biopsies in magnetic resonance imaging positive zones.

Design, setting, and participants: We retrospectively analyzed 171 men receiving initial MR/US fusion biopsy at our institution from 2015 to 2018.

Outcome measurements and statistical analysis: Disparity was defined as positive targeted but negative systematic biopsy within an magnetic resonance imaging-positive zone (PIRADS 3+), or vice versa. Multivariable logistic regression was used to identify factors associated with disparity in detection of cancer on a per lesion basis.

Results and limitation: Three hundred and fifty-five lesions were targeted. For any cancer and clinically significant prostate cancer (csPCa), 37 (10%) and 24 (7%) lesions were target positive/systematic negative, respectively, while 30 (8%) and 23 (6%) lesions were target negative/systematic positive. In multivariable analysis, anterior location (OR 4.1, 95% CI 1.5-11.4, P = 0.007) was associated with csPCa target positive/systematic negative disparity, while higher prostate volume (OR 1.14, 95% CI 1.0-1.29, P = 0.04) was associated with csPCa target negative/systematic positive disparity. Shorter distance from apex (OR 1.02, 95% CI 1.01-1.04, P = 0.02) was associated with target positive/systematic negative disparity for any cancer. Limitations included relatively limited sample size and lack of prostatectomy specimen as a gold standard.

Conclusions: Anterior or apical lesion location favors better disease capture on targeted biopsies. When doing systematic-only biopsies, surgeons may consider sampling the anterior zone separately.

Keywords: Imaging; MR/US-fusion biopsy; MRI; Prostate cancer.

MeSH terms

Humans
Image-Guided Biopsy / methods
Magnetic Resonance Imaging
Male
Prostate* / diagnostic imaging
Prostate* / pathology
Prostate* / surgery
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / surgery
Retrospective Studies